An Introduction to TCCC: The Three Phases of Care

Tactical Combat Casualty Care (TCCC) is the evidence-based set of guidelines that revolutionized military pre-hospital medicine and forms the basis of all instruction provided by CPR-Life Services. It is a framework designed to reduce preventable combat death by providing proven, effective treatments at the point of injury. TCCC is structured into three distinct phases, with the appropriate medical care dictated by the tactical situation.  

Phase 1 is Care Under Fire (or Care Under Threat in the civilian context). This phase occurs while the responder and casualty are under direct and immediate threat. The tactical priority is to neutralize the threat and move the casualty to safety. Medical intervention is extremely limited: the only action taken is to control life-threatening external hemorrhage with a tourniquet if tactically feasible. The guiding principle is to prevent further casualties and not become one yourself.

Phase 2 is Tactical Field Care. This phase begins once the casualty is no longer under direct hostile fire, allowing for more time and safety to render aid. It is during this phase that the bulk of medical interventions are performed, following the M.A.R.C.H. algorithm. Responders can assess for other injuries, manage airways and breathing, and begin to treat for shock and hypothermia.

Phase 3 is Tactical Evacuation Care (TACEVAC). This phase occurs while the casualty is being evacuated to a higher level of medical care, whether by ground vehicle, helicopter, or other means. Care during this phase is similar to Tactical Field Care but includes additional considerations for monitoring the patient during transport and preparing them for handoff to a medical facility. Understanding these three phases is critical to making sound decisions under pressure.

Be prepared. Be Confident.